The approved Medicaid waiver, as the changes are called, will make many Medicaid enrollees work, volunteer or do other activities for 80 hours a month to keep health coverage. It also will limit access to dental and vision services for some, make other enrollees pay premiums and install lock-out periods for not making those payments.

The Department for Health and Human Services based the approval on a section of the Social Security Act that the advocacy groups say doesn’t give the federal government authority.

The changes are aimed at decreasing what the state will have to pay to run the program, which was expanded to cover many more people under the Affordable Care Act. But the changes also would make it harder for people to keep their Medicaid coverage.

The federal approval came 17 months after the changes were first submitted. The Bevin administration says it will reach out to enrollees starting Friday, and the program will kick off in July.